Surgical and radiologic anatomy : SRA
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An understanding of the microsurgical anatomy of the arachnoid membranes and the subarachnoid cisterns is important in minimally invasive neurosurgery. But the topography of the arachnoid membranes has not been completely elucidated. The description of the distribution and the configuration of the intracranial arachnoid membranes is still a subject of controversy. ⋯ Almost all the cranial nerves were encased by their own arachnoidal sheaths when they crossed the cisterns. The arachnoid membranes and trabeculae must be dissected or incised sharply during the operations. Thorough knowledge of the anatomy of the intracranial arachnoid membranes is valuable to take full advantage of the natural anatomic landmarks and interfaces formed by them during surgery.
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This study aims to investigate the anatomy of the greater palatine foramen (GPF), greater palatine canal (GPC) and pterygopalatine fossa (PPF) with special reference to the blockage of the maxillary nerve. A correlation between the length of GPC and PPF and the heights of the orbit and the maxilla was also studied using simple linear regression analysis. The morphology of the GPF, GPC and PPF as well as heights of the orbit and the maxilla were assessed in 105 Thai skulls. ⋯ Two models for estimating the depth of needle injection in maxillary nerve block have been developed as follows: Length of GPC and PPF=19.038+0.314 (orbital height) and length of GPC and PPF=21.204+0.187 (maxillary height). The calculated length combined with the mucosal thickness was the estimated depth of needle injection. In conclusion, our results concerning the GPF, GPC and PPF will provide the useful reference for clinicians to anesthetize the maxillary nerve with a greater degree of success.
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Cerebral perfusion during carotid cross-clamping depends on collateral function of the circle of Willis. The aim of this study was to determine the value of 3D Phase-Contrast (3D PC) MR angiography in predicting pre-operatively the need of shunting. ⋯ 3D PC MR angiography can significantly determine the need of shunting in patients with important risk of immediate intraoperative cerebral ischemia. It also focuses on the intraoperative blood pressure stability in patients with moderate risk of ischemia.
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Forty three cadavers of adult and five patients were included in our study. Accessory, suprascapular, musculocutaneous and sural nerves were dissected. These widely used nerves in brachial plexus reconstruction have varying anatomy and still have no standard approach for surgery. ⋯ Long nerve graft is necessary during brachial plexus reconstruction when many interposition grafts are needed. Technique of multiple (4-7) transverse skin incisions let us to get sural nerve with both branches as long as 66 cm (average 47 cm). Total length of this nerve mainly depended on branching level, which was found to be 27.5 cm (9-35) measuring proximally from the lateral ankle.
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Non-specific low back pain and peripartum pelvic pain have aetiologies that may feature the sacroiliac region. This region possesses many potential pain-generating structures sharing common sensory innervation which makes clinical differentiation of pathoanatomy difficult. This anatomical study explores the relationship between the long posterior sacroiliac ligament (LPSL) and the lateral branches of the dorsal sacral nerve plexus. ⋯ We found that the LPSL is penetrated by the lateral branches of the dorsal sacral rami of predominantly S2 (96%, 21/22) and S3 (100%, 22/22), variably of S4 (59%, 13/22) and rarely of S1 (4%, 1/22). Some of the penetrating lateral branches give off nerve fibres that disappear within the ligament. These findings provide an anatomical basis for the notion that the LPSL is a potential pain generator in the posterior sacroiliac region.